Provider Demographics
NPI:1730459264
Name:PURAN P MATHUR, M.D., PC
Entity Type:Organization
Organization Name:PURAN P MATHUR, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALOYSIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-258-1904
Mailing Address - Street 1:11520 SWAINS LOCK TER
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1200
Mailing Address - Country:US
Mailing Address - Phone:301-343-7089
Mailing Address - Fax:301-765-9003
Practice Address - Street 1:2401 RESEARCH BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3215
Practice Address - Country:US
Practice Address - Phone:301-330-6985
Practice Address - Fax:301-330-6984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD35941207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD202381400Medicaid
MD202381400Medicaid
DC641274Medicare PIN